The addition of tomosynthesis to mammography provided better screening performance and lower recall rates, as well as higher invasive cancer detection in younger women, based on a recent study.
In women under age 50, recall rates for those undergoing conventional mammography was 115 per 1,000 cases compared with 108 per 1,000 cases for tomosynthesis (3D mammography), for a 6% reduction in recalls reported Stephen Rose, MD, chief medical officer of Solis Mammography, a group of 30 clinics headquartered in Addison, Texas.
Also, cancer detection rates were 2.1 for mammography compared with 3.1 with the addition of tomosynthesis, while invasive cancer detection rates improved from 1.2 to 1.8 with the addition of tomosynthesis, he said in a presentation at the Radiological Society of North America (RSNA) annual meeting.
This represented a relative increase in invasive cancer detection of 67%, he noted.
For the study, Rose examined the results of 65,457 screening examinations among women under age 50 — 45,320 had conventional mammography and 20,137 underwent mammography plus tomosynthesis. The studies were done from Jan. 1, 2015 to Dec 31, 2015. Women screened with tomosynthesis plus mammography paid an out-of-pocket fee, Rose explained.
He also noted that “with tomosynthesis, we were able to find more cancers in women with dense breast tissue. In fact, using digital mammography we were unable to find any cancers in women with dense breast tissue.”
Overall, the addition of tomosynthesis increased the positive predictive value (PPV) of the screening by more than 56%, Rose said. The debate over screening women in their 40’s for breast cancer is still an issue, with the U.S. Preventive Services Task Force suggesting that mammography screening should begin at age 50, and the American Cancer Society recommending that annual screening begin at age 45, but women can opt for screening starting at age 40.
But Rose noted that as many as 20% of invasive cancers are found in women under the age of 50, and breast cancer in these women are the cause of more life-years lost to the disease. “More aggressive, rapidly developing cancers are more likely in women diagnosed under the age of 50,” he told MedPage Today.
Bottom line: 3D tomosynthesis mammography improves cancer detection in women under the age of 50. Tomosynthesis is more effective in dense breast tissue which is more prevalent in women under the age of 50.
About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.